Melanoma facts
What is melanoma?
Melanoma is a cancer that develops in melanocytes, the pigment cells present in the skin. It can be more serious than the other forms of skin cancer because it may spread to other parts of the body (metastasize) and cause serious illness and death. About 50,000 new cases of melanoma are diagnosed in the United States every year.
Because most melanomas occur on the skin where they can be seen, patients themselves are often the first to detect many melanomas. Early detection and diagnosis are crucial. Caught early, most melanomas can be cured with relatively minor surgery.
This article is written from the standpoint of the patient. In other words, instead of describing the disease in exhaustive detail, I will try to help answer the questions: "How do I know if I have melanoma?" and "Should I should be checked for it?"
Spots on the skinGuideline # 1: Nobody can conclusively diagnose him- or herself. If someone sees a spot that looks as though it is new or changing, he or she should show it to a doctor. When it comes to spots on the skin, it is always better to be safe than sorry.
Everybody gets spots on their skin. The older we are, the more spots of different types we have. Most of these spots are benign. That means they are neither cancerous nor on the way to becoming cancerous. These may include freckles, benign moles, collections of blood vessels called cherry angiomas, or raised, irregular bumps on the skin called seborrheic keratoses that appear to be stuck on to the skin.
MolesGuideline # 2: The vast majority of moles stay as moles and do not turn into anything else. Most melanomas do not arise in preexisting moles. For that reason, having all of one's moles removed to "prevent melanoma" does not make clinical sense.
Some people are born with moles (the medical name is "nevus," plural "nevi"). Almost everyone develops them, starting in childhood. On average, people have about 25 moles, though some have fewer and others many more. Moles may be flat or raised, and they may range in color from tan to light brown to black. Moles may lose their color and end up flesh colored. It is unusual to develop new pigmented moles after age 35.
What does melanoma look like? What are melanoma symptoms and signs?
Guideline # 3: A changing spot may be a problem, but not every change means cancer. A mole may appear and then get bigger or become raised but still be only a mole. It is normal for many moles to start flat and dark, become raised and dark, and then later lose much of their color. This process takes many years.
Most public-health information about melanoma stresses the so-called ABCDEs:
These guidelines are somewhat helpful, but the problem is that many normal moles are not completely symmetrical in their shape or color. This means that many spots, which seem to have one or more of the ABCDEs, are in fact just ordinary moles and not melanomas. Additionally, some melanomas do not fit this description but may still be spotted by a primary-care physician or dermatologist. Not all melanomas have color or are raised on the skin. Amelanotic melanomas have little or no color to the naked eye and may be confused with traumatized benign nevi or basal cell carcinoma. Desmoplastic melanoma may appear to be a thickened area of skin like a scar. These are treated the same way as more typical melanomas but, in the latter case, may be more difficult to determine the exact margins of the tumor.
As a rule, melanoma is not painful unless traumatized. They sometimes itch, but this has no diagnostic or prognostic importance.
What if the skin changes are rapid or dramatic?
Guideline # 4: The more rapid and dramatic the change, the less serious the problem.
When changes such as pain, swelling, or even bleeding come on rapidly, within a day or two, they are likely to be caused by minor trauma, often a kind one doesn't remember (like scratching the spot while sleeping). If a spot changes rapidly and then goes back to the way it was within a couple of weeks, or falls off altogether, it is not likely to represent anything serious. Nevertheless, this would be a good time to say once again: Nobody can diagnose him- or herself. If one sees a spot that looks as though it is new or changing, show it to a doctor. If one see a spot that doesn't look like one's other spots, it should be evaluated.
What are the causes and risk factors for melanoma?
Guideline # 5: Individual sunburns do raise one's risk of melanoma. However, slow daily sun exposure, even without burning, may also substantially raise someone's risk of skin cancer.
Factors that raise one's risk for melanoma include the following:
The presence of close (first-degree) family with melanoma is a high risk factor, although looking at all cases of melanoma, only 10% of cases run in families.
Having a history of other sun-induced skin cancers, such as the much more common basal cell or squamous cell carcinomas, indirectly raises one's risk because they are markers of long-term sun exposure. The basic cell type is different, however, and a basal cell or squamous cell carcinoma cannot "turn into melanoma" or vice versa.
How can people estimate their level of risk for melanoma?
The best way to know one's risk level is to have a dermatologist perform a full body examination. That way one will find out whether the spots one has are moles and, if so, whether they are funny looking in the medical sense.
The medical term for such moles is atypical. This is a somewhat confusing term, because among other things the criteria for defining it are not clear, and it's not certain that an atypical mole is necessarily precancerous. Patients who have lots of "atypical moles" (more than 24) do have a higher risk for developing melanoma but not necessarily within one of their existing funny-looking moles. It may be a challenge to find the "baby melanoma" in the middle of a back full of large, dark, or irregular moles. If someone has such moles, a doctor will recommend regular surveillance and may recommend biopsy of the most unusual or worrisome looking moles.
Sometimes, one learns at a routine skin evaluation that one does not necessarily need annual routine checkups. In other situations, a doctor may recommend regular checks at six-month or yearly intervals.
What are the types of melanoma?
The main types of melanoma are as follows:
There are also other rarer forms of melanoma that may occur, for example, under the nails (subungual), on the palms and soles (acral lentiginous), uveal or choroidal (ocular), oral or vulvar mucosa, or sometimes even inside the body.
How is melanoma diagnosed?
Most doctors diagnose melanoma by examining the spot causing concern and doing a biopsy. A skin biopsy refers to removing all or part of the skin spot under local anesthesia and sending the specimen to a pathologist for analysis.
The biopsy report may show any of the following:
Some doctors are skilled in a clinical technique called epiluminescence microscopy (also called dermatoscopy or dermoscopy). They may use a variety of instruments to evaluate the pigment and blood vessel pattern of a mole without having to remove it. Sometimes the findings support the diagnosis of possible melanoma, and at other times, the findings are reassuring that the spot is nothing to worry about. The gold standard for a conclusive diagnosis, however, remains a skin biopsy.
What is the treatment for melanoma?
In general, melanoma is treated by surgery alone. Doctors have learned that surgery does not need to be as extensive as was thought years ago. When treating many early melanomas, for instance, surgeons only remove 1 centimeter (less than ½ inch) of the normal tissue around the melanoma. Deeper and more advanced cancers may need more extensive surgery.
Depending on various considerations (tumor thickness, body location, age, etc.), the removal of nearby lymph nodes may be recommended. For advanced disease, such as when the melanoma has spread to other parts of the body, treatments like immunotherapy or chemotherapy are sometimes recommended. Many of these treatments are still experimental and, for that reason, their use may be limited to patients willing to participate in a research study.
How do doctors determine the prognosis (outlook) of a melanoma?
The most useful criterion for determining prognosis is tumor thickness. Tumor thickness is measured in fractions of millimeters and is called the Breslow's depth. A related prognostic measure is the Clark's level, which describes how many skin layers the melanoma penetrates. The lower the Clark's level and the smaller the Breslow's depth, the better the prognosis. Any spread to lymph nodes or other body locations dramatically worsens the prognosis.
Thin melanomas, those measuring less than 1 millimeter, have excellent cure rates. The thicker the melanoma, the less optimistic the prognosis. Early diagnosis and treatment are essential.
What methods are available to help prevent melanoma?
Conclusions
When it comes to spots on the skin, it is always better to be safe than sorry. Melanoma is a potentially serious form of skin cancer. Diagnosed early and treated properly, it can very often be cured with relatively minor surgery alone.
What research is being done on melanoma?
Research in melanoma is headed in three directions: prevention, more precise diagnosis, and better treatment for advanced disease.
What does melanoma look like? What are melanoma symptoms and signs?
Guideline # 3: A changing spot may be a problem, but not every change means cancer. A mole may appear and then get bigger or become raised but still be only a mole. It is normal for many moles to start flat and dark, become raised and dark, and then later lose much of their color. This process takes many years.
Most public-health information about melanoma stresses the so-called ABCDEs:
These guidelines are somewhat helpful, but the problem is that many normal moles are not completely symmetrical in their shape or color. This means that many spots, which seem to have one or more of the ABCDEs, are in fact just ordinary moles and not melanomas. Additionally, some melanomas do not fit this description but may still be spotted by a primary-care physician or dermatologist. Not all melanomas have color or are raised on the skin. Amelanotic melanomas have little or no color to the naked eye and may be confused with traumatized benign nevi or basal cell carcinoma. Desmoplastic melanoma may appear to be a thickened area of skin like a scar. These are treated the same way as more typical melanomas but, in the latter case, may be more difficult to determine the exact margins of the tumor.
As a rule, melanoma is not painful unless traumatized. They sometimes itch, but this has no diagnostic or prognostic importance.
What if the skin changes are rapid or dramatic?
Guideline # 4: The more rapid and dramatic the change, the less serious the problem.
When changes such as pain, swelling, or even bleeding come on rapidly, within a day or two, they are likely to be caused by minor trauma, often a kind one doesn't remember (like scratching the spot while sleeping). If a spot changes rapidly and then goes back to the way it was within a couple of weeks, or falls off altogether, it is not likely to represent anything serious. Nevertheless, this would be a good time to say once again: Nobody can diagnose him- or herself. If one sees a spot that looks as though it is new or changing, show it to a doctor. If one see a spot that doesn't look like one's other spots, it should be evaluated.
What are the causes and risk factors for melanoma?
Guideline # 5: Individual sunburns do raise one's risk of melanoma. However, slow daily sun exposure, even without burning, may also substantially raise someone's risk of skin cancer.
Factors that raise one's risk for melanoma include the following:
The presence of close (first-degree) family with melanoma is a high risk factor, although looking at all cases of melanoma, only 10% of cases run in families.
Having a history of other sun-induced skin cancers, such as the much more common basal cell or squamous cell carcinomas, indirectly raises one's risk because they are markers of long-term sun exposure. The basic cell type is different, however, and a basal cell or squamous cell carcinoma cannot "turn into melanoma" or vice versa.
How can people estimate their level of risk for melanoma?
The best way to know one's risk level is to have a dermatologist perform a full body examination. That way one will find out whether the spots one has are moles and, if so, whether they are funny looking in the medical sense.
The medical term for such moles is atypical. This is a somewhat confusing term, because among other things the criteria for defining it are not clear, and it's not certain that an atypical mole is necessarily precancerous. Patients who have lots of "atypical moles" (more than 24) do have a higher risk for developing melanoma but not necessarily within one of their existing funny-looking moles. It may be a challenge to find the "baby melanoma" in the middle of a back full of large, dark, or irregular moles. If someone has such moles, a doctor will recommend regular surveillance and may recommend biopsy of the most unusual or worrisome looking moles.
Sometimes, one learns at a routine skin evaluation that one does not necessarily need annual routine checkups. In other situations, a doctor may recommend regular checks at six-month or yearly intervals.
What are the types of melanoma?
The main types of melanoma are as follows:
There are also other rarer forms of melanoma that may occur, for example, under the nails (subungual), on the palms and soles (acral lentiginous), uveal or choroidal (ocular), oral or vulvar mucosa, or sometimes even inside the body.
How is melanoma diagnosed?
Most doctors diagnose melanoma by examining the spot causing concern and doing a biopsy. A skin biopsy refers to removing all or part of the skin spot under local anesthesia and sending the specimen to a pathologist for analysis.
The biopsy report may show any of the following:
Some doctors are skilled in a clinical technique called epiluminescence microscopy (also called dermatoscopy or dermoscopy). They may use a variety of instruments to evaluate the pigment and blood vessel pattern of a mole without having to remove it. Sometimes the findings support the diagnosis of possible melanoma, and at other times, the findings are reassuring that the spot is nothing to worry about. The gold standard for a conclusive diagnosis, however, remains a skin biopsy.
What is the treatment for melanoma?
In general, melanoma is treated by surgery alone. Doctors have learned that surgery does not need to be as extensive as was thought years ago. When treating many early melanomas, for instance, surgeons only remove 1 centimeter (less than ½ inch) of the normal tissue around the melanoma. Deeper and more advanced cancers may need more extensive surgery.
Depending on various considerations (tumor thickness, body location, age, etc.), the removal of nearby lymph nodes may be recommended. For advanced disease, such as when the melanoma has spread to other parts of the body, treatments like immunotherapy or chemotherapy are sometimes recommended. Many of these treatments are still experimental and, for that reason, their use may be limited to patients willing to participate in a research study.
How do doctors determine the prognosis (outlook) of a melanoma?
The most useful criterion for determining prognosis is tumor thickness. Tumor thickness is measured in fractions of millimeters and is called the Breslow's depth. A related prognostic measure is the Clark's level, which describes how many skin layers the melanoma penetrates. The lower the Clark's level and the smaller the Breslow's depth, the better the prognosis. Any spread to lymph nodes or other body locations dramatically worsens the prognosis.
Thin melanomas, those measuring less than 1 millimeter, have excellent cure rates. The thicker the melanoma, the less optimistic the prognosis. Early diagnosis and treatment are essential.
What methods are available to help prevent melanoma?
Conclusions
When it comes to spots on the skin, it is always better to be safe than sorry. Melanoma is a potentially serious form of skin cancer. Diagnosed early and treated properly, it can very often be cured with relatively minor surgery alone.
What research is being done on melanoma?
Research in melanoma is headed in three directions: prevention, more precise diagnosis, and better treatment for advanced disease.
Source: http://www.rxlist.com
When changes such as pain, swelling, or even bleeding come on rapidly, within a day or two, they are likely to be caused by minor trauma, often a kind one doesn't remember (like scratching the spot while sleeping). If a spot changes rapidly and then goes back to the way it was within a couple of weeks, or falls off altogether, it is not likely to represent anything serious. Nevertheless, this would be a good time to say once again: Nobody can diagnose him- or herself. If one sees a spot that looks as though it is new or changing, show it to a doctor. If one see a spot that doesn't look like one's other spots, it should be evaluated.
Source: http://www.rxlist.com
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